Surf and Science Waitlist | Paddle for Peace

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Waitlist for Surf and Science

Participant Name (The person surfing)

Participant Age

Email

Emergency Contact

Mailing Address

Emergency Contact Phone

Please list all allergies for participant.

Please list any and all medical conditions for participant. If none, write NA.

PARENTS: Woud you like to be contacted for volunteer/chaperon opportunities during the program? *

Yes

Not at this time

Your Child's Ethnicity

What Program is your child registering for?

Your childs experience with surfing *

Never surfed

Tried once

Experienced Surfer

Your child's experience with snorkeling? *

Never Tried

Tried Once

Experienced Snorkeler

How comfortable is your child in the ocean? *

My child cant swim

Not comfortable

Somewhat comfortable

Comfortable

How often do your family visit the beach annually? *

Never Been

1-3 times a year

We go often

What prevents your family from getting to the beach regularly? Check all that apply. *

Financial Hardship

Transportation Barriers

Lack of resources (i .e surfboard, wetsuit)

Lack of community/support

Not comfortable in the ocean

Lack of BIPOC Representation at the coast

Nothing, we go often

Other: Please explain

What do you hope your child gains from this program?

How did you hear about us?

Parent Signature

Date

By signing this form, you agree to the terms and conditions listed here.

I accept terms & conditions

I want to subscribe to the newsletter.

Thank you for signing up for our Waitlist! We will be in touch soon!

Contact Us: hello@paddleforpeace.org

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